Articulate is not a compliment: Ending the pervasive culture of racial microaggressions in medicine.

I remember being ushered into an empty office and sitting down in a red chair placed directly in front of a cherry wood desk. Picture frames of a white family — mother, father, daughter, son- graced the desk in the office. I glanced repeatedly at the walls were decorated with multiple framed diplomas as I sat nervously in the chair. Abruptly, the door swings open and a slender white woman with a brown bob dressed in a grey suit rushes into the room and seats herself behind the cherry-wood desk. She apologizes for her tardiness and introduces herself as the dean of student affairs at the medical school. “I’ve read all about you.” she says “Now tell me again, why do you want to be a doctor?” I proceed to go through my story, the one I had rehearsed countless times. The story about my origins of being the daughter to a Nigerian immigrant visiting nurse who would take me with her on home visits, my close relationship with my pediatrician, my summers in Nigeria seeing family members who lived in extreme poverty and how it had all culminated in an innate desire to help people.

It was a powerful story.

I stopped, ready to field any and all clarifying questions related to the monologue I had just delivered. The dean cleared her throat, looked at me and said one sentence. “Wow, you are so well-spoken.” And then she waited. I believe she was waiting for a response of gratitude to what she believed was a compliment. So I smiled and muttered a “Thank you so much.”. After that, she proceeded to rattle off facts about the prestige of the medical school, including their robust commitment to having a diverse student body. Yet, I don’t remember the rest of the interview day, but I remember that scene vividly. I couldn’t then and still can’t shake the thoughts that entered my mind- was she listening to my story or was she amazed at the fact that I could put multi-syllabic words together coherently, despite completing high school and college?

That was my first microaggression, which happened over 15 years ago, but certainly not my last. I think many of us as women physicians have had the “pleasure” of being mistaken for a nurse. Yet as a Black woman physician, I remember walking into a room to see the next patient during my emergency medicine rotation. Despite having my white coat and stethoscope on, before I could utter a word, I was quickly told by the mother of the patient in the bed that the lunch tray was in the corner and thanked for coming in to pick it up. Just fyi: I walked out and never returned.

I recall being greeted during medical school numerous times with a “Yo, how ya doing?” by fellow white students, because that’s how “we” speak, right? More recently, as an attending physician, I was asked at the end of a clinic visit- “It was nice meeting you but when is the real doctor coming in?”. I wish I could say during each of those incidents I responded with a witty and stinging remark that made them feel the pain that I felt from each incident. Unfortunately, I wasn’t built like that back then. Actually, I hardly even acknowledged them as offenses back then but I did know that they induced a negative feeling about myself, close to self-doubt about my belonging in this profession.

It wasn’t until residency when I realized that the constant barrage of these tiny mosquito bites, had created a full-blown allergic reaction of constantly feeling that I didn’t belong. It led to me trying to figure out what repellent I could wear everyday to stop the bites. I tried different ones- becoming invisible and not talking or drawing attention to myself during rounds would help. I tried pulling back my growing natural locks into a bun, that would help people see my white coat and stethoscope and finally realize I was a physician, right?

It wasn’t until becoming an attending in academic medicine and mentoring residents from backgrounds that were under-represented in medicine, that I realized that my silence and proclivity to just tolerate these words and behaviors, like many before me, were equally at fault. I was expecting change but had endured this pain in silence and to be frank I was reluctant to jeopardize my job, my reputation or my future career. It was heartbreaking to hear stories from medical students and residents nationally. One poignant moment was when a Black male medical student was interviewing with the dean of a medical school and was told that he would enjoy the school because they have basketball courts. I winced at the fact that despite the growing language of diversity, equity and inclusion, the endemic nature of microaggressions directed towards those who are underrepresented in power, leadership and numbers is still alive and well.

I am well aware that as a Black woman, this shouldn’t be my battle to fight. I didn’t create the problem, so why should I be responsible for being vocal about this issue. However, the impact of tolerating insidious, everyday discrimination and racial microaggressions, microinsults and microinvalidations on the mental health of Black women has been documented in multiple research papers. These documented effects have included increased depression, anxiety and even post-traumatic stress. The need to recover from these traumas in a safe space, was the reason I created a collective for women physicians of color to receive coaching, education and community to build resilience and move forward their personal ambitions and their calling.

So I write this essay as a starting point for discussion. Although there is so much attention on physician burnout, the wear and tear caused by microaggressions and racism in healthcare is hardly ever brought into these discussions. We all, particularly our White colleagues, need to prioritize the mental health risk that our brightest and best doctors face when there is a commitment to diversity, yet no training, education and accountable policies to create more inclusive environments in our medical education and healthcare delivery institutions. My sisters of color, we also cannot continue to keep our stories and experiences a secret and allow for these indignities to occur unchecked. I am committed to increasing the 2%- the percent of physicians in the US who are Black women- but I cannot honestly and ethically mentor a little Black girl to enter medicine and become a doctor, if I have not done my due diligence to ensure that her health and well-being will not be jeopardized by doing so.

Solutions include making spaces for us to share and document the injustices and issues that we have endured. They are not trivial nor have we overreacted. Once documented, en masse, we need to push our institutions at the leadership level to discuss their plan of action to address these wrongs and prevent them from recurring in our institutions without any corrective measures. Medicine can no longer propagate a system that thrives on some physicians keeping our stories invisible. The solution to the struggle is inextricably linked to our stories and our voices. Full stop.

And to all of you who continue to think that saying a person of color is articulate is a compliment, please stop. It is a big deal. I never want you to remember how fantastically articulate I was when I shared my story but how powerful my story moved you to think and hopefully change.

Omolara Thomas Uwemedimo, MD, MPH

CEO and Founder, Melanin, Medicine & Motherhood

Dr. Omolara Thomas Uwemedimo is a board certified pediatrician for over 15 years, public health professor, researcher and health equity advocate for women and children of color. Dr. Uwemedimo is CEO of Strong Children Wellness, a community-based medical practice in New York and founder of Melanin, Medicine & Motherhood, an organization focused on supporting the retention of Black women physicians in medicine, in order to ensure equitable for families of color. She has dedicated the majority of her career to communities of color, by providing medical care as well as developing programs to strengthen delivery of integrated healthcare and health education. She has worked in NYC, Boston and globally in 12 countries across sub-Saharan Africa, Asia and the Caribbean. She is a national speaker to both physician and community audiences in the fields of implicit bias in healthcare settings, inclusion and equity for women physicians in healthcare, racism in health, and health of marginalized children and families, including immigrants, low-income and racial/ethnic minorities. She has been featured in several media outlets including Newsweek, Reuters, NPR and CNN.